What is the Children’s Health Insurance Program (CHIP)?

The Children’s Health Insurance Program (CHIP) was signed into federal law in 1997, and exists to help fund health coverage for children at the state level. Each state has their own program in place, working to primarily serve low-income households. These households are often out of the eligibility range to qualify for Medicaid, or may have workplace insurance that does not cover their children.

CHIP eligibility differs state by state, with the majority of states covering children with household incomes up to at least 200% of the Federal Poverty Level (FPL). This post will expand upon the key components of CHIP, and outline the steps required to secure this coverage for your children.

One quick note before we begin. If you have been keeping up with news concerning CHIP, you know that the program did expire in September of 2017. States were left to operate on what funds they had remaining, leaving the future of the program uncertain. In January of 2018, President Trump signed a 6 year reauthorization into law. One month later, Congress passed the Bipartisan Budget Act of 2018, extending CHIP for an additional 4 years. These actions ensure the program’s funding through 2027.

Who is covered by CHIP?

Although CHIP receives fund matching from the federal government, each individual state has their own operating guidelines. However, every state’s program will provide basic coverage for uninsured children 19 years old and under, belonging to households with an income too high to qualify for Medicaid. Since rules vary, the best way to determine your children’s eligibility is to check in with your state (steps for doings so below).

How do I enroll my child?

It’s easy to learn your children’s eligibility status or apply for CHIP. The fastest way to determine if your household meets state income requirements is to call 1-800-318-2596 (HealthCare.gov). Your declared income and household size will determine eligibility.

You can also learn about eligibility during Marketplace Open Enrollment. After completing your application for coverage (as head of household) your state’s Health Insurance Marketplace should contact you regarding eligibility. In the event that your state does not contact you regarding CHIP, you can always reach out to HealthCare.gov.

Note: like Medicaid, CHIP does not have a set enrollment period and can be applied for year-round!

What is covered?

Despite the fact that each state determines eligibility a bit differently, all states provide the same basic coverage under their CHIP programs. Required components of CHIP include:

  • Routine check-ups
  • Immunizations
  • Primary care visits
  • Prescriptions
  • Dental
  • Vision
  • Hospital care (in and out patient)
  • Emergency services (ambulance, ER)

It’s important to note that annual “well child” primary care and dental visits are free under this program. To learn more about what additional benefits your state may provide, refer to the drop down menu at InsureKidsNow.

When do I renew?

CHIP coverage does not automatically renew year over year. If your child benefits from the program, you will receive a mailed renewal form 90 days before the end of coverage. If you do not receive a renewal notice in the mail, call 1-800-318-2596.

Renewing your child’s coverage is simple. You just have to provide your household income (the same amount you will declare on your taxes), the SSN and birthdate for each applicant, and any private health insurance information (only applicable if you had private insurance at any point in the previous 90 days). Complete the form provided by your state’s Health Insurance Marketplace, and mail it back!

Can I enroll my child in both CHIP and a Marketplace plan?

The short answer is yes, but doing so will exempt you from certain savings. If your child is CHIP eligible and you want to enroll them in a Marketplace plan, you cannot use advanced premium tax credits (APTC) to reduce the cost of their coverage. For this reason, solely enrolling your child in a CHIP plan tends to be the most affordable.

Enrolling in health insurance can seem daunting, especially if you have several dependents under the age of 19. Programs like CHIP exist to make determining and securing coverage simple and effective. Every child deserves quality health insurance and we hope this article helped you understand a little more about this program.


HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance.

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